Care Manager

Description

Role Summary

Care Managers conduct high‑volume outbound calls to payors/pharmacy benefit managers (PBMs) to determine whether commercially insured patients on supported products are eligible for copay support. This role is phone‑intensive (up to 95% of the shift on calls), requires disciplined use of approved call guides, precise documentation in our systems, and professional customer service on recorded lines. There is no patient or caregiver interaction in this role.

Essential Duties & Responsibilities

• Make outbound PBM/payor calls for copay eligibility throughout the workday; maintain phone engagement up to 95% of the shift while executing the correct outbound campaigns and dispositions.

• Follow approved Call Guides to ask structured, plan‑identifying questions of PBM agents; use compliant script/verbiage and payor‑call steps.

• Determine and record the verified plan type: Traditional, Accumulator, Hybrid Accumulator, Maximizer, or Hybrid Maximizer, etc. using program definitions and SOPs.

• Use PBM‑specific prompts (e.g., BIN/PCN/Group workflows, NPI handling, maximizer screening questions) to obtain the benefit details needed for eligibility determination.

• Document every interaction accurately and in real time: complete call‑guide fields, outcomes, and notes in the designated CRM/telephony tools before taking/making the next call.

• Create and manage follow‑up activities/tasks as needed with timely completion.

• Maintain availability/status discipline in the telephony platform (Available/Ready, appropriate Away Codes, correct outbound campaign selection) to maximize connect time.

• Adhere to program compliance and quality standards (privacy, script adherence, recorded‑call protocols) and participate in QA monitoring.

• Collaborate professionally with payor/PBM contacts and internal teams; route inquiries outside program scope through approved channels.

Customer Service & Conduct

• Demonstrate courtesy, respect, empathy, and a service‑first mindset on every payor/PBM interaction.

• Apply active listening and de‑escalation techniques with agents as needed.

• Uphold workplace conduct guidelines and use only approved systems/channels for communications and documentation.

Qualifications

• High‑volume outbound call center experience (PBM/payor calling preferred); comfort with phone‑based work for the majority of the shift.

• Familiarity with pharmacy benefit verification and PBM processes; ability to identify and document the plan types listed above using call‑guide prompts.

• Computer proficiency: CRM/telephony tools, accurate typing, structured note‑taking, and data entry.

• Strong listening, questioning, and problem‑solving skills; ability to follow SOPs and escalate internally when payor information is incomplete or conflicting.

• Professional verbal communication; consistent, courteous demeanor on recorded lines.

• Education

• High School Diploma or equivalent (some college preferred).

• Experience

• Call Center Experience:

o Minimum 1–2 years in a high volume call center environment

• Insurance Verification / Pharmacy Benefits:

o At least 1 year experience in insurance verification, pharmacy benefit investigation, or related healthcare services (medical billing, prior authorization support).

• Preferred: Familiarity with PBM processes, copay assistance programs, and benefit plan types (Traditional, Accumulator, Maximizer).

Performance Metrics (Examples)

• Phone time/adherence (targeting up to 95% outbound activity).

• Call‑guide adherence and QA scores; correct plan‑type identification per program definitions.

• Documentation completeness and timeliness; follow‑up task creation and completion rate.

Work Conditions & Schedule

This is a remote phone‑based, payor/PBM‑facing role conducted on recorded lines. Copay Business hours are 8am to 8pm EST. However, candidates in this role may be assigned Standard business hours with shift assignments; overtime or campaign support may be requested during peak periods.

Skills

insurance verification, prior authorization, medical insurance, Customer service, Multi tasking, Call center

Top Skills Details

insurance verification,prior authorization,medical insurance,Customer service,Multi tasking

Additional Skills & Qualifications

1. High School Diploma or equivalent, some college preferred

2. Minimum 6 months to one year experience in medical billing, insurance verification, or similar related medical office experience

3. Previous data entry experience (minimum three months) and ability to type 30wpm+

4. Able to demonstrate high attention to detail in work

5. Must be computer savvy, to include navigating multiple computer tabs, monitors and applications

6. Advanced ability/knowledge of all Microsoft Suite programs (Teams, Word, Excel, Outlook, etc) and soft phone systems (WebEx, Mitel, Shoretel, etc.)

7. Exceptional communication skills, both written and verbal

8. Able to work in a virtual team environment by being available and responsive during working hours

9. Excellent follow through

10. This is a remote position. Employees must have a private workspace free of distraction to adhere to HIPAA compliance/guidelines. Workspace must include internet plug-in accessibility. Wi-fi connectivity is not permitted.

11. A working cell phone is required for 2 step authentication verifications during the length of the assignment.

Experience Level

Entry Level

#priorityeast

This is a Contract position based out of Columbus, OH.

The pay range for this position is $21.00 - $21.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully remote position.

This position is anticipated to close on Jan 23, 2026.

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

About TEKsystems and TEKsystems Global Services

We’re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We’re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We’re building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.